This from Ruckensteinās 2011 discussion on dizziness (he and Staab ā when Staab was still at U of P [now at Mayo] ā first advanced the concept in around 2005).
Vague sensation of light-headedness, subjective sensations of imbalance. These complaints, which can be characterized by their imprecision, are consistently among the most common that clinicians encounter when evaluating dizziness. Eliciting a history from these patients can be frustrating; often, they cannot describe their symptoms precisely. Rather than feeling frustrated, one can feel encouraged because the nonspecific, non-physical nature of the complaints leads to a specific diagnosis. Formerly referred to as āpsychogenic dizziness,ā persistent nonspecific dizziness that cannot be explained by active medical conditions is now a defined clinical entity known as chronic subjective dizziness, or CSD.3,4 Barber has noted that this diagnosis is suggested during the first 5 to 10 minutes of the office visit if the patient has no specific physical complaints.5
Diagnostic criteria for CSD include greater than 3 months of sensations such as nonvertiginous dizziness, lightheadedness, heavy-headedness or subjective imbalance present on most days, as well as greater than 3 months of chronic hypersensitivity to oneās own motion or the movement of objects in the environment.3,4 Complex visual stimuli, such as walking in grocery stores or shopping malls, or using a computer, characteristically exacerbate the symptoms. The physical examination is usually normal in these patients, except that hyperventilation typically reproduces their symptoms.
CSD most commonly represents a chronic anxiety disorder with or without associated panic and/or phobic disorders. Although the patientās history may strongly suggest CSD, a full neurotologic history taking and physical examination must be performed, and selective tests, such as videonystagmography (VNG) and MRI, also are frequently ordered. This is done to reassure the clinician andāperhaps even more importantāthe patient that no organic disease is present.
Treatment of these patients incorporates typical strategies used to manage anxiety disorders. Slowly increasing doses of selective serotonin reuptake inhibitors are the mainstay of treatment, often coupled with psychotherapeutic approaches such as cognitive behavioral therapy.
Not sure I see why this is harder to accept than the notion that there is something āoffā in our perception of things that results in the feeling of imbalace (the notion of proprioceptive inputs being the issue)? I think it all falls back to the stigma of āmentalā issues as opposed to āphysicalā issues. Most of us will readily admit to anxiety, yet most of us are also quick to say, āof course I am anxious ā I feel dizzy all the time.ā It is highly possible, at least in my case, that I donāt know which came first ā the chicken or the egg. Richy, I agree with your initial comment ā I donāt really care if it is migranous in origin, mal de debarquement, chronic subjective dizziness, cervicogenic in nature or the result of withdrawing from a benzodiazepene (all of these are potentially applicable in my case). All I really care about is a way to fix the problem, and my suspicion is (and always has been once I educated myself) that there is significant overlap in these various areas such that a lot of the pharmacological treatments hit the same spot so that whatever your particular specialist focuses on will be his or her diagnosis and, if the treatment works, thatās what you have. There is no definitive etiological cause but the label sticks. For some, where the history supports one versus the other, it is likely to lean in that direction, but it is far from definitive.
Bottom line ā I would try all the possible treatments to see if one works for you, regardless of what it is called.
Andy
